Abstract
In patients with osteoarthritis (OA) and severe osseous deformity of the knee, total knee replacement (TKR) is a major challenge. If the preoperative deformity exceeds 15°, restoration of the correct mechanical alignment will be difficult to achieve. In the management of medial compartment OA associated with a deformity of more than 15°, there is no agreement on the policy to adopt. The first step to be taken is a detailed analysis of the deformity, to determine where it is articular (wear, laxity) or extra-articular (constitutional or acquired bony deformity). The options open to the surgeon are: isolated valgus osteotomy (with TKR at a later stage), TKR or one-stage opening-wedge tibial valgus osteotomy and TKR. This chapter examines the different options and describes the authors’ preferred strategy.
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References
Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg (Am) 65: 619–628
Tew M, Waugh W (1985) Tibiofemoral alignment and the results of knee replacement. J Bone and Joint Surg (Br) 67: 551–556
Jonsson B, Åström J (1988) Alignment and long-term clinical results of a semi-constrained knee prosthesis. Clin Orthop 226: 124–128
Teeny SM, Krackow KA, Hungerford DS, Jones M (1991) Primary total knee arthroplasty in patients with severe deformity. A comparative study. Clin Orthop 273: 19–31
Wolff AM, Hungerford DS, Pepe CL (1991) The effect of extra-articular and valgus deformity on total knee arthroplasty. Clin Orthop 271: 35–51
Dejour H, Neyret P, Bonnin M (1994) Instability and osteoarthritis. In: Fu FH, Harner CD, Vince GV, Editors. Knee surgery. Baltimore: Williams & Wilkins, 859–875
Moreland JR, Basset LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg (Am) 69: 745–749
Cameron HU, Welsh RP (1988) Potential complications of total knee replacement following tibial osteotomy. Orthop Rev 17: 39–43
Neyret P, Deroche P, Deschamps G, Dejour H (1992) Prothèses totales de genou après ostéotomie tibiale de valgisation. Rev Chir Orthop 77: 438–448
Karachalios T, Sarangi PP, Newman JH (1994) Severe and valgus deformities treated by total knee arthroplasty. J Bone and Joint Surg (Br) 76: 938–942
Mont MA, Alexander N, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. Orthop Clin North America 25: 515–525
Hungerford DS, Insall JN (1997) Extra-articular deformity in TKA. 14th annual current concepts in joint replacement. Cleveland, OH Session XVII Papers 86 and 87
Rivat P, Neyret P, Ait Si Selmi T (1999) Influence de l’ordre des coupes, coupes dépendantes et indépendantes, rôle du tenseur. Neuvièmes Journées lyonnaises de chirurgie du genou et de l’épaule. Montpellier. Sauramps Medical 41–76
Ait Si Selmi T, Tayot O, Trojani C, Neyret P (1999) Gestes ligamentaires dans l’équilibrage des protheèses totales du genou. Neuvièmes Journés lyonnaises de chirurgie du genou et de l’épaule. Montpellier. Sauramps Medical 21–40
Godenèche A (1998) Prothèses totales du genou et ostéotomies dans le même temps opératoire pour gonarthrose avec déviations axiales majeures (á propos de 11 cas). Comparaison avec deux séries de 11 protheèses pour grands genu valgum et 12 prothèses sur grands genu varum. Thèse de meédecine n° 68
Zanone X, Ait Si Selmi T, Neyret P (1999) Prothèse totale et ostéotomie tibiale de correction simultanées pour gonarthrose sur genu valgum excessif constitutionnel. Rev Chir Orthop 85: 749–756
Dejour H, Deschamps G (1989) Technique opératoire de la prothèse totale à glissement du genou. Cahier Sci Paris 35: 13–23
Faris PM (1994) Soft tissue balancing and total knee arthroplasty. In: Fu FH, Harner CD, Vince GV, Editors. Knee surgery. Baltimore: Williams & Wilkins 1385–1389
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Neyret, P., Lustig, S., Guyen, O. et al. Total knee replacement in severe genu varum deformity. Interact Surg 3, 6–12 (2008). https://doi.org/10.1007/s11610-007-0039-1
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DOI: https://doi.org/10.1007/s11610-007-0039-1